What Should I Do if My Workers’ Compensation Claim is Delayed?

A workplace injury can seriously impact an employee’s life physically, financially, and emotionally. A serious or catastrophic injury can result in a permanent disability that affects a person’s earning capability, both present and future. The trauma of a work accident can be difficult to recover from emotionally and leave scars that are psychological, as well as physical. Medical bills from workplace injuries can add up quickly, adding more stress to an already traumatic situation.

If a work injury prevents an employee from returning to work for more than seven days, they are entitled to temporary disability benefits. Workers’ Compensation benefit checks should begin within two weeks of when the work injury was reported, but this is not always the case. If a claim is delayed, it is important to speak to a Workers’ Compensation lawyer.

What are the Basics of a Workers’ Compensation Claim?

Some of the basics that must be investigated in any Workers’ Compensation claim include:

  • Date of Injury: This must be verified by the insurance company paying the claim.
  • Insurance Check: To verify that the employer was insured on the date of the injury.
  • Employment Check: To verify that the worker filing the claim is indeed employed by the insured employer.

Additionally, the insurance company will investigate to see if the work injury was duly reported to the employer; if there were witnesses to the work accident, the details of the work accident, and resulting injury; and if medical treatment was sought and administered. They may use an investigator to obtain statements from the injured worker and witnesses or a lawyer who may take depositions.

What are Common Causes for Delays in Workers’ Compensation Claims?

There are many factors that can lead to a delay in processing a Workers’ Compensation claim. Every work injury is different and involves a unique set of circumstances. Often, delays are bureaucratic in nature and result from the time it takes to gather medical reports and other evidence. Injuries caused by machine malfunction, equipment failure, and serious neglect may also warrant extensive investigation that takes more than the usual two weeks to issue a check.

Mistakes in paperwork and clerical errors can also cause a delay in processing a Workers’ Compensation claim. Some insurance companies are understaffed, leaving overworked or poorly trained insurance adjusters to deal with heavy caseloads. Additionally, there are also many cases in which claims are deliberately delayed in order to avoid paying benefits or to reduce the amount of a settlement being paid to a worker.

The cause of a claim being delayed can also rest with the employer. Often, the reason can be a lack of clear reporting procedures, such as when supervisors do not communicate with the employer about the claim. Failure to handle the claim properly is another problem and can be an issue if the correct forms are not submitted to the appropriate authority.

Are There Deadlines for Insurance Companies to Process Claims?

In both New Jersey and Pennsylvania, there are laws to protect employees from unreasonable delays in processing Workers’ Compensation claims. Unreasonable delays are illegal in New Jersey, and an employer or insurance company must pay 25 percent above the amount of the claim for hindering, preventing, or delaying a claim longer than 30 days.

In Pennsylvania, it is illegal to use processing delays as a negotiating tactic, and penalties can be imposed by the courts for failure to approve or deny a claim within 21 days of receiving notification. Pennsylvania law also requires that insurers provide claimants with written explanation for claims every 45 days that pass the first 30-day deadline. The law in both states requires employers to have Workers’ Compensation insurance. Attempting to interfere with an employee’s Workers’ Compensation claim is illegal.

Can My Employer Retaliate Against Me for Filing a Claim?

By law, employers must carry Workers’ Compensation insurance, and almost all workplace injuries and illnesses are covered with few exceptions. It is the worker’s right to receive benefits for injuries or illnesses sustained in the course of employment. Retaliation against someone filing a claim for benefits is prohibited by law. Some employers may take retaliatory measures in order to avoid paying benefits, to replace an injured employee, or to avoid accommodating an employee who returns to work with job restrictions. Retaliation can take the form of the following actions:

  • Increasing surveillance of the employee
  • Denying additional benefits
  • Giving unjustified negative performance reviews
  • Denying a raise or promotion
  • Demoting the employee or decreasing their wages
  • Threatening verbal remarks
  • Giving unjustified negative job references

These tactics can intimidate not only the worker who files a claim for benefits, but their colleagues as well. If the unhappy worker resigns from their position voluntarily, the employer can avoid paying for unemployment benefits and is also free from the threat of a wrongful termination lawsuit.

Do I Need a Lawyer if My Claim is Delayed?

It is not necessary to hire a lawyer to file a claim for Workers’ Compensation benefits. In certain situations, an injured worker can benefit tremendously from the experience of a seasoned Workers’ Compensation lawyer. The employer and the insurance company have lawyers working on their behalf. In the case of a delayed claim, the worker will have more of a level playing field if they are not the one dealing directly with the insurer.

A good lawyer will also investigate the work accident and gather all evidence needed to support a successful claim. They should have extensive knowledge of the state Workers’ Compensation system and may know the judges holding the hearings on claims. All the stresses of meeting legal deadlines and filing paperwork falls to the lawyer so that the worker can concentrate on their recovery.

Is it Costly to Hire a Lawyer?

Many workers are concerned about the expenses associated with hiring a lawyer to represent them. The good news is that most lawyers operate on a contingency basis. This means that lawyer fees are contingent upon winning the case, and the worker does not pay anything until the case is resolved successfully. Using an experienced lawyer makes sense after considering what is at stake. A worker who is injured on the job has a right to medical benefits, wage loss benefits, temporary or permanent disability benefits, and benefits for scarring and disfigurement. Also, a family may be eligible for death benefits after a fatal work accident.

Delays in Workers’ Compensation benefits extends suffering for the victim. Whether these delays stem from incompetence, bureaucracy, or are a deliberate tactic to avoid payment, an injured worker should seek the advice of an experienced lawyer.

Bucks County Workers’ Compensation Lawyers at Freedman & Lorry, P.C. Fight for Injured Workers

If you were injured in a work-related accident and your benefits have been delayed, contact an experienced Bucks County Workers’ Compensation lawyer at Freedman & Lorry, P.C. Call us today at 215-925-8400 or complete our online form for a free consultation today. Located in Philadelphia, and Cherry Hill, New Jersey, we serve clients throughout Pennsylvania.